Investigation of Causes and Evaluation of Programs: three applications of Health Economics

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Virginia Tech

In chapter 1, a comprehensive meta-analysis is conducted to synthesize the effectiveness, cost, and cost-effectiveness of lifestyle diabetes prevention interventions and compare effects by intervention delivery agent and channel. Sixty-nine studies meet inclusion criteria. The results show that participants receiving intervention with nutrition education experienced a reduction of 2.07 kg (95% CI: 1.52 to 2.62; p<0.001; 95% CI: 88.61% to 92.87%) in weight at 12 months with effect sizes over time ranging from small (0.17, 95% CI: 0.04 to 0.30; p=0.012; 95% CI: 80.42% to 91.14%) to medium (0.65, 95% CI: 0.49 to 0.82; p<0.001; 95% CI: 98.52% to 98.94). In sum, lifestyle interventions are effective in reducing body weight and glucose-related outcomes. Dietitian-delivered interventions achieve greater weight reduction compared to those delivered by other personnel.

In chapter 2, this study attempts to examine the effects of household relative deprivation on children's health outcomes. A modified household production model is developed with energy intake, energy expenditure and a composite good as main inputs in the health production. A two-stage Stackelberg game facilitates the need to model the parent-child interaction which follows similar structure as You and Davis (2011). We use three measurements of relative deprivation based on per capita household income and four reference groups based on combinations of geographic and demographic characteristics. The results show that relative deprivation is negatively associated with child health.

In chapter 3, we define "process benefits" as the direct effect on utility from engaging in an activity and examine how "process benefits" associated with food activities, both uptake and duration, are related to factors such as socio-economic status and demographics. A household production model is utilized to demonstrate the vital role of process benefits in home food production and the implications it will have for nutrition based policies targeting resources. The results display that the process benefits are associated with some demographic characteristics. This implies that shortfalls in food activities are not simply a matter of technology or resource shortfalls, but also reflect disutility associated from these activities which in turn will attenuate the impact of policies design to merely address resource shortfalls.

Nutrition education, Type 2 diabetes, Relative deprivation, Process benefits, Household production framework